Mental health and the Bondi killer

Sam Hawley: That a man could walk into a shopping centre on a busy Saturday afternoon and go on a stabbing spree is horrifying and it’s hard to understand how anyone could do that. It’s left so many people demanding answers. Today we have a look at the offender, Joel Couchi’s mental health history and ask whether anything could have been done to stop the attack and save lives. I’m Sam Hawley on Gadigal land in Sydney. This is ABC News Daily.

ABC News clip: It’s an attack that’s shocked a city and a nation. Six innocent people killed in a stabbing spree at a busy shopping centre in Sydney’s east.

Anthony Cooke, NSW Police Assistant Commissioner: We are continuing to work through the profiling of the offender but very clearly to us at this stage it would appear that this is related to the mental health of the individual involved.

Michele Cauchi: This is a parent’s absolute nightmare when they have a child with a mental illness that something like this would happen and my heart goes out to the people our son has hurt. If he was in his right mind he would be absolutely devastated at what he has done.

Andrew Cauchi: To you, he’s a monster. To me he was a very sick boy. Believe me he was a very sick boy.

Kimberlie Dean: Hi, I’m Professor Kimberlie Dean. I’m a forensic psychiatrist and as well I’m a researcher and an educator in the field of forensic mental health.

Sam Hawley: Kimberlie, the Westfield knife attack, it’s an absolute tragedy of course for so many people and it’s just really hard to comprehend, isn’t it, that six lives were lost? Yes. And of those people that they were in their prime, they had everything to live for. I guess as women as well we can really relate to some of the victims, you know, in terms of age or mothers. Really hard to comprehend.

Kimberlie Dean: It absolutely is very shocking and I think most people can kind of imagine themselves, all people they know in exactly that innocent situation of being in a shopping centre and for something so horrendous to happen. It’s really, for most people, completely unbelievable.

Sam Hawley: Yeah, and it’s really important I think to understand how this could have happened. It’s really important to get a sense of that. Yes. We know Kimberlie, the offender, 40-year-old Joel Couchi, had a long history of mental illness and we learnt a lot about him from his parents this week, didn’t we?

Michele Cauchi: We are just ordinary people, brought up our son as best we could. We did what we could for him, he got a degree.

Andrew Cauchi: I don’t know what’s wrongI don’t know what’s with him, why he would do this. I did everything in my power to help him.

Kimberlie Dean: Yes, the little I’ve seen of the interviews with his parents is also pretty heartbreaking to listen to and to be honest fairly familiar to, it would be to mental health professionals, to hear their story and the frustration that they’ve had in trying to support their son who’s had a serious and complex mental health problem for a very long time.

Sam Hawley: Yeah, he was diagnosed with schizophrenia when he was just 17, so it’s an illness that he’s had for a very long time. Yes. They live in Toowoomba, his parents, west of Brisbane and that’s where Joel Couchi grew up and as soon as they saw the television vision on Saturday afternoon, they knew it was their son and that he’d done the unspeakable. I mean, absolutely shocking to see that.

Andrew Cauchi: I mean, how would you feel if your son was the man that I recognised on TV and I rang the New South Wales Police and I said, look, if you don’t know a motive, I’ll give you one, he’s got schizophrenia… My wife said, this looks like Joel. When you saw his head on the stairway…

Sam Hawley: And we know from his parents that he was diagnosed, you know, a long time ago and he was in the care of doctors for about 18 years. He did well at school, according to his parents. He graduated from university. He was very high functioning, by the sound of it.

Kimberlie Dean: Yes, I mean, it’s obviously really difficult. I wouldn’t want to comment too much on the details of his case and his diagnosis. You know, I don’t know the circumstances, but certainly people who have severe and complex mental health problems like schizophrenia, every case is very different. And even the diagnosis of schizophrenia, it doesn’t refer to a single disease, really. It refers to a whole, probably a whole range of different problems that we fit under that category. It’s not uncommon for people to develop this kind of disorder at about that kind of age, you know, peak age of onset, sort of late teens into early adulthood. And people can certainly have had, you know, quite well functioning lives up until that point and be really completely derailed by the onset of illness. But that’s not true for everyone. You know, some people experience an episode of psychosis, is the term we use, and never do again. You know, others can be quite well in between episodes. Some people deteriorate over time. It’s really, it’s very variable and very individual and depends on lots of other things.

Sam Hawley: His parents seem to suggest that things really started to change in the past five years. He was moving between cities, Brisbane to Toowoomba, the Gold Coast. Of course, he ended up in Sydney. They do mention that he stopped taking medication and stopped treatment. How concerning is that?

Kimberlie Dean: Well, it’s also not an uncommon picture. One of the difficulties for people with these kind of severe and complex mental health problems is that they don’t always appreciate themselves, that they need help, treatment and support. And sometimes the treatments, particularly the medication that’s prescribed, while it can be very effective for the symptoms of psychosis, they come often with side effects, which people find hard to tolerate, and they’re not always fully effective even for the symptoms of psychosis. So it’s not as straightforward, and people often don’t recognise that they need help. They become completely dominated by the experiences they’re having, this change in reality that they experience. They might have delusional ideas, be very paranoid. They might be hearing voices. You know, those kind of experiences become really dominating of their lives, and it’s very hard to make what we would otherwise think of as sort of rational decisions to seek help and to take treatment.

Sam Hawley: In 2023, Andrew Couchi, his father, recalled a really disturbing thing, that his son had returned home with a set of US Army combat knives, and that really worried him. Police actually became involved at this point.

Andrew Cauchi: And he had a fascination with knives. You know, I watch these guys in America who kill people, and they’ve got a fascination with guns. And so if you’ve got a mental illness and you’ve got a fascination with guns, there’s a chance of you using them.

Sam Hawley: But as we know, of course, he ended up in Sydney, and the rest is just an absolute tragedy. So I guess, Kimberlie, the question that a lot of people have now after this tragedy is could it have been avoided? Police have stressed he was known to them, but he’s never been charged with any criminal offence. And the Queensland Police Assistant Commissioner, Roger Lowe, he’s made the point that being mentally ill, it’s not a crime.

Roger Lowe, Queensland Police Assistant Commissioner: We have people in our society who suffer from mental health. They go about their days without trouble, without causing these type of crimes. Mental health in society is not a crime. And we do not run an intelligence regime on persons who suffer from mental health.

Kimberlie Dean: That’s true, right. Absolutely. I was pleased to read those comments from the police. And I think it’s first important to say that, you know, I can’t really comment on what would have made a difference in this case. I don’t know the details, and there’s going to be an extensive inquiry into all of those aspects. And to be honest, even when you know all of the details and you get to the end of these inquiries, it’s not always that clear that anything in particular would have made a specific difference in this case. You know, it’s not as often a very complex set of circumstances. I think this case does highlight that there is this group of people in our community who, and not in significant number, schizophrenia is not common, but it’s about 1 per cent of the population, so it’s not rare either. And so there’s a group of people in our community who I think most clinicians working in the area would say are not sufficiently well served by our current services in Australia. I think services, especially public mental health services, state-based public mental health services, are really stretched. They really find it difficult to provide the level of care to this group. We don’t have sufficient supported housing. Joel was homeless and itinerant, as you describe, and that’s also not an uncommon combination and is probably an additional risk. But I think we need to properly fund our public mental health services for this group in particular. Seeing better outcomes and overall seeing a reduced level of risk, then I think we need to address the resource shortages, the staff shortages, with real trouble recruiting and retaining staff in this area. It needs to be an area of focus for government.

Sam Hawley: I was going to say, is there any way, do you think that he could have been labelled as a potential risk to others, given the history with knives? Did he fall through the cracks?

Kimberlie Dean: I really think that’s an impossible to answer question at this stage. And as I say, I’m not sure it will even be that clear at the end of a really thorough inquiry whether that would have made any difference. Identifying people who present a risk to others is actually really challenging. There are a lot of people with severe and complex mental health problems who don’t present any risk and it’s quite hard to separate those who do from those who don’t. So I think the better message is really about improving the level of care and support for this group as a whole.

Sam Hawley: Just tell me, Kimberlie, what can we do if we’re out and about and we see someone who’s obviously suffering from really bad mental health? What should we do, given what’s happened in Bondi?

Kimberlie Dean: I sometimes wonder that myself as a psychiatrist, wandering around the community and seeing people in those obvious circumstances. I don’t think there’s not a lot an individual can do in those kind of moments and I wouldn’t really advocate that people try and intervene themselves. I think if they’re really worried that there are some risks or hazards around, I think they can call the police or they can call an emergency mental health number. One of the services models that’s developed for this group is community mental health teams that focus specifically on people who are not living in secure accommodation and those kind of services, I think, are the kind that we might want to look at expanding and really supporting. That’s really, I think, all we can do, as well as advocating to improve the treatments and supports for this group of people.

Sam Hawley: Is there more that police could be doing, ensuring that people are referred to the services that you mention?

Kimberlie Dean: I think police have a tough job in this context. They really do. It’s not their area of expertise, but it is a really significant proportion of their work and I think many police would tell you it’s the most difficult part of their work. So I would advocate for more training and more support for the police in this area. We don’t need them to be mental health clinicians, but they need to know enough about how the service works, where they can take people, how they can best approach people in these circumstances. So every step of the service process needs to be, I think, a focus for governments to improve.

Sam Hawley: Professor Kimberlie Dean is a forensic psychiatrist…from the University of New South Wales. If this episode has raised any issues for you or anyone you know – Lifeline is one service that can help. Contact them on 13 11 14. This episode was produced by Bridget Fitzgerald and Nell Whitehead. Audio production by Sam Dunn. Our supervising producer is David Coady. I’m Sam Hawley. ABC News daily will be back again tomorrow. You can find all of our episodes of the podcast on the ABC listen app. Thanks for listening.